Nurses with the New York City Health and Hospitals Corporation are finding that spending more focused time with patients with hypertension, giving them tools to manage their condition at home and following up with stated goals gets positive results.
The nurses are leading a program called Treat to Target, which started in 2012 at seven HHC facilities and has since spread to all 11 hospitals and six diagnostic and treatment centers.
Monefa M. Anderson, RN, BSN, MPA, deputy director, nursing administration at Lincoln Medical Center in the Bronx and co-chairwoman, HHC Ambulatory Care Leadership Council, said all of the facilities have seen an increase in their hypertension control rates.
Treat to Target changes the normal pattern of care where patients see a physician, get sent home with medication and come back in to get their blood pressure checked.
Now, if the primary care physician finds high blood pressure, the patient is recommended for Treat to Target and meets with a nurse in the same appointment. A nurse can start a conversation about what’s keeping a patient from controlled pressure by asking where and with whom they live, what they eat and what their daily routine is like.
Were looking at a more interactive way to treat hypertension, Anderson said. The nurses give patients blood pressure monitors and show them how to use them and log the results. Nurses follow up with phone calls and office visits. The message the patient gets, Anderson said, is someone cares for me. Someones watching. Someones helping.
Logging their own results and self-monitoring helps patients with adherence, she said. When patients see that taking their medication helps with a good reading the next day, they gain motivation to keep taking it.
Nursing skills ideal
Nurses were ideal candidates to lead the program because they are nurturers and educators, Anderson said. Those skills help nurses get to the root cause of what’s preventing patients from controlling blood pressure.
Lincoln started ramping up the program in July 2013 and has seen 400 patients with hypertension in that time. About 100 patients have graduated, Anderson said, meaning they have their hypertension under control for two to three readings and can go back to just seeing the physician, freeing up nurses to work with new patients.
Patients bring families back
Doris Amalu, RN, a staff nurse at Harlem Hospital Center, said the program includes nurses working with patients during appointments every two weeks until their blood pressure is under control.
Amalu said the patients have more opportunity to express themselves when they have extended appointments with nurses.
We have seen some of the patients bring back family and their friends to come and receive the same care when they have high blood pressure, she said.
Affects 1 in 3 adults
Hypertension can have serious consequences if not managed. It affects about 1 in 3 U.S. adults, according to the Centers for Disease Control and Prevention. Only 47% have their condition under control.
Nana Lau, RN, chronic disease nurse at Renaissance Health Care Network Diagnostic and Treatment Center in Manhattan, said the program allows time to get to the root of what is keeping patients from achieving their goals. Nurses work closely with patients to improve outcomes, Lau said.
One of Laus patients was a woman who was frustrated because she thought she was doing everything right. However, the patient kept having elevated readings and felt she was letting the healthcare team down. When Lau asked more questions and listened, she discovered the woman was eating a daily can of sardines, which has many nutrients but a high sodium content and can contribute to hypertension. Lau also discovered the patient was taking her medication once a day, but the prescription was for twice a day. Changing those patterns and introducing her to a dietitian helped get her hypertension under control within a few visits.
At Renaissance, 24 of the 183 patients have achieved control since the program started in August 2013, according to Lau.
Im like a cheerleader, a mentor, nudging people, to help them get healthy, she said.
Marcia Frellick is a freelance writer.